Study Design

Prospective cohort study of blunt trauma patients from 10 Canadian EDs (community and university hospitals), where each pt was evaluated for 20 standardized clinical findings before radiographs (3 views). Flex/Ex views and CT C-spine underwent at discretion of treating physician. Subset of patients were also assessed by second EM physician independently. Additional 5 demographic variables obtained by study RNs from hospital records. Clinical decision rule derived using statistical means (see article for more detail)

Clinically important C-spine injury (fx, dislocation or ligamentous instability on imaging) was the primary outcome measure, which requires stabilization or specialized follow-up. The following injuries were not considered clinically important:

Isolated avulsion fx of osteophyte

Isolated transverse process fx involving facet joint

Isolated spinous process fx not involving lamina

Simple compression fx (<25% vertebral body height)

Inclusion Criteria

Patients sustaining acute blunt trauma to head/neck, who were at risk for C-spine injury, which is defined as the following: